Wednesday, September 22, 2010

Susan's Unfortunate Encounter with a Brown Reculse Spider

Toward the end of our last trip to Yellowstone, which took place on Saturday, September 11, we decided to read Evening Prayer and a chapter from Thomas Keating at a picnic table by Otter Creek, which was a lovely setting (see picture). It was a beautiful day. A large raven kept coming near to us and "hacking" as if he (or she) was trying to cough something up. In hindsight, Susan feels it was a conspiracy and that the raven was trying to distract her while a brown recluse spider bit her! She never felt anything, which we later discovered is pretty typical of brown recluse spider bites. On the way home, she complained that her finger was itching and that it felt something like a mosquito bite. We didn't think much more of it.

On Sunday we went to church and to breakfast afterwards and walked around Cody for a little. We went back to the Thomas the Apostle Retreat Center and Susan complained about her finger and showed it to me. There was a small blue/black growth (see picture). I said to her, "Let's go, we're going to the Emergency Room." We had seen the hospital several times in passing and as it is adjacent to the Buffalo Bill Cody Historic Center, we had no difficulty finding it.

There was no one in the waiting room and they took Susan right in, but not before we noticed a large United States map on the wall with orange labels all over it indicating where in the country people had come from when they found themselves in this ER. Of course, because Cody is a major entrance point for Yellowstone they get people from around the country. They also see a wide variety of problems. Around the border of the map was space to indicate the specific emergency that had brought people in. Hand-written entries indicated various wounds and injuries (e.g. bicycle accident, sprained ankle SPIDER BITE!) The intake person saw us looking at the map and said, "That's right, you're now a statistic!"

Susan was quickly seen by a triage nurse and it wasn't long before the ER doctor on duty came in. He was very kind, and also quite thorough. He told us that 99% of people who come in believing they have a brown recluse spider bite actually have contracted a staph infection. In looking at Susan's wound, he felt she was among the 1% that actually had been bitten by a brown recluse spider. We were asked if we had brought the spider with us. Of course we hadn't; Susan didn't even know when she had been bitten. Without the spider, there is no way to definitively determine that it actually was a brown recluse spider. We later discovered (thanks to my favorite on-line source Wikipedia) that a brown recluse's venom is more toxic than a rattlesnakes, but the effects of the bite are not as severe (though still very serious) because the amount of venom delivered in the bite is much less.

He gave her antibiotics and told her she had to see her own physician at home. He also told us that she would likely be referred to a hand surgeon who would at some point probably need to cut out the infected skin once the toxin stoppped spreading. The venom actully kills tissue. We were told to watch the would for growth.

The next day, Monday, we got on our flight in the morning and headed back to Florida, arriving late in the evening. Susan called en route and made an appointment with our physician in Florida. In the meantime, the wound was growing and looking increasingly inflamed.

On Tuesday morning, she went for her appointment. They had not seen anything like this before. They took a culture and sent her immediately to Dr. Angelo Incorvaia in Boynton Beach who is a hand surgeon. He was just terrific. He was not convinced it was a brown recluse spider bite and thought it looked like staph. When I showed him the photo I had taken, he then said that it may be a brown recluse spider bite. He also took a culture.

We explained to him that we were scheduled to leave for New York on Thursday (2 days from then) and that we were headed first to New York and then overseas including Israel, Egypt and Jordan. We had particular concerns about conditions in Egypt. "What would you do if this were your wife?" I asked him. "I'd put her on IVs with antibiotics," he answered without hesitation. That was what we did.

Susan went to an Infectious Disease Office at the corner of Congress and Golf Road right away and got hooked up for IVs. She did the same on Thursday morning at 8:00 AM and saw Dr. Incorvaia again after that appointment. We were supposed to fly to New York on Thursday, but we missed our flight, in part because this had thrown us a curve ball and we still had things to get done. It worked out for the best though, as she got additional antibiotics by IV on Friday morning before we did actually leave.

Susan was instructed to soak her finger in Epsom salts and hydrogen peroxide three times a day and she was put on a course of oral antibiotics. As I write this, it is Wednesday, September 22 and we are in Jerusalem. The wound is healing and she is doing as she was instructed. Hopefully, the spider bite, which did turn out to become a MRSA staph infection, will heal. We are watching it very carefully. Now all Susan has to do is stay away from scorpions while we're in the desert!